[Congressional Bills 105th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1364 Introduced in House (IH)]







105th CONGRESS
  1st Session
                                H. R. 1364

 To provide grants to States to provide uninsured children with access 
  to health care insurance coverage and to amend the Internal Revenue 
 Code of 1986 to increase the excise taxes on tobacco products for the 
        purpose of funding such grants and reducing the deficit.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             April 17, 1997

 Mrs. Johnson of Connecticut (for herself, Mr. Matsui, Mr. Riggs, Mr. 
 Stark, Mrs.  Morella, Mrs. Roukema, and Mr. McGovern) introduced the 
following bill; which was referred to the Committee on Commerce, and in 
  addition to the Committees on Ways and Means, and Education and the 
 Workforce, for a period to be subsequently determined by the Speaker, 
 in each case for consideration of such provisions as fall within the 
                jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
 To provide grants to States to provide uninsured children with access 
  to health care insurance coverage and to amend the Internal Revenue 
 Code of 1986 to increase the excise taxes on tobacco products for the 
        purpose of funding such grants and reducing the deficit.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Child Health 
Insurance and Lower Deficit Act of 1997''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Purposes.
           TITLE I--CHILDREN'S HEALTH INSURANCE GRANT PROGRAM

               Subtitle A--Voluntary State Grant Programs

Sec. 101. Authority to establish.
Sec. 102. Requirements for qualifying children's policy.
Sec. 103 Requirements for qualifying children's direct service benefit 
                            option.
Sec. 104. Other requirements.
                         Subtitle B--Assistance

                     Part 1--Assistance to Families

Sec. 121. Eligibility determinations.
Sec. 122. Assistance to families.
Sec. 123. Penalties for material misrepresentation and false 
                            information.
Sec. 124. Aggregate Federal grant payments.
Sec. 125. Authorization of appropriations and deficit reduction.
     Part 2--Services for Pregnant Women, New Mothers, and Infants

Sec. 131. Program for pregnant women and infants.
          Subtitle C--Definitions and Miscellaneous Provisions

                          Part 1--Definitions

Sec. 141. Definitions.
                    Part 2--Miscellaneous Provisions

Sec. 151. Other contributions to premiums.
Sec. 152. Maintenance of effort.
Sec. 153. Application of other requirements and State flexibility.
Sec. 154. Regulations.
             Part 3--Conforming Amendments; Effective Date

Sec. 161. Conforming amendments.
Sec. 162. Effective date.
         TITLE II--INCREASE IN EXCISE TAXES ON TOBACCO PRODUCTS

Sec. 201. Increase in excise taxes on tobacco products to fund child 
                            health insurance grants and lower the 
                            deficit.

SEC. 2. PURPOSES.

    It is the purpose of this Act to benefit American families by--
            (1) providing grants to States to develop and implement a 
        voluntary program to help purchase health coverage for 
        uninsured, needy children; and
            (2) acquiring resources targeted to help reduce the Federal 
        budget deficit that, if unchecked, will require American 
        families to devote an increasing proportion of their tax 
        liability to service the debt.

           TITLE I--CHILDREN'S HEALTH INSURANCE GRANT PROGRAM

               Subtitle A--Voluntary State Grant Programs

SEC. 101. AUTHORITY TO ESTABLISH.

    (a) State Election.--Each State may elect to establish a children's 
health insurance program that complies with this title.
    (b) State Plan.--
            (1) In general.--To apply to participate under this 
        subtitle, a State shall, not later than 90 days prior to the 
        beginning of the calendar year in which the State program is to 
        begin, prepare and submit to the Secretary a State plan for the 
        operation of the program.
            (2) Approval by secretary.--The State plan submitted by a 
        State under paragraph (1) must be approved by the Secretary in 
        order for the State to be eligible to receive a grant under 
        this title.
    (c) Use of Funds.--Under a program under this title, a 
participating State shall provide subsidies, consistent with section 
122, for coverage under a qualifying children's policy and a qualifying 
children's direct service benefit option.

SEC. 102. REQUIREMENTS FOR QUALIFYING CHILDREN'S POLICY.

    (a) In General.--Each participating State--
            (1) shall contract with health insurance issuers to make 
        qualifying children's policies available to subsidy eligible 
        children in the State;
            (2) shall ensure that qualifying children's policies are 
        available to all eligible children in the State and that each 
        eligible child has the opportunity to enroll for coverage under 
        such policies;
            (3) shall ensure that a qualifying children's policy 
        provides coverage for the care described in subsections (b) and 
        (c);
            (4) shall provide for the payment of premium and cost 
        sharing subsidies (in amounts as defined by the State in 
        accordance with section 122), that may include vouchers, to or 
        on behalf of subsidy eligible children, except that a State 
electing to participate may not--
                    (A) provide a premium subsidy that is less than 95 
                percent for a subsidy eligible child in a family with a 
                family income below 185 percent of the poverty line for 
                a family of the size involved;
                    (B) allow the imposition of cost-sharing 
                requirements for preventive services provided to a 
                subsidy eligible child; or
                    (C) enter into a contract with a health insurance 
                issuer offering a qualifying children's policy that 
                requires that a subsidy eligible child (in a family 
                with a family income below 150 percent of the poverty 
                line for a family of the size involved) pay more than 
                20 percent of the cost-sharing otherwise applied under 
                such contract as applied with respect to a particular 
                item or service unless the cost-sharing required under 
                the contract involved has been deemed by the Secretary 
                as not being a barrier to care for children of families 
                below 150 percent of poverty line for a family of the 
                size involved.
    (b) Coverage for Medical Care.--For purposes of this title, a 
qualifying children's policy is a policy for an eligible child that 
provides coverage for medical care for such child that either (at the 
option of the State)--
            (1) is the equivalent of the medical assistance available 
        (other than cost sharing) to children under the State plan 
        under title XIX of the Social Security Act (42 U.S.C. 1396 et 
        seq.), or
            (2) is comparable to the health benefits plan that is 
        offered under the Federal Employees' Health Benefits Program 
        (under chapter 89 of title 5, United States Code) and that is 
        the plan with the largest enrollment of individuals under such 
        Program.
    (c) Access to Specialty Care for Special Needs Children.--Each 
participating State shall assure that each qualifying children's policy 
ensure access to pediatric primary and specialty care providers, 
including centers of pediatric specialized treatment expertise.
    (d) Access.--
            (1) Access to policies.--In carrying out subsection (a)(1), 
        a participating State shall, subject to the funding limitation 
        described in section 122(d), ensure that subsidy eligible 
        children have access to a qualifying children's policy provided 
        by a health insurance issuer serving the area in which the 
        eligible child resides. Such policies may be offered to 
        eligible children residing in the State through existing public 
        and private purchasing sponsors.
            (2) To traditional providers.--A participating State shall 
        ensure that a qualifying children's policy provides access to 
        traditional providers who have experience in serving 
        populations covered under this title and in areas in which such 
        populations reside.

SEC. 103 REQUIREMENTS FOR QUALIFYING CHILDREN'S DIRECT SERVICE BENEFIT 
              OPTION.

    (a) In General.--Each participating State--
            (1) for each area of the State served by a health center 
        (as defined in section 330), shall contract directly with the 
        health center to provide services under the program under this 
        title for subsidy eligible children who choose to receive 
        services from the health center;
            (2) shall ensure that under a qualifying children's direct 
        service benefit option, coverage is provided for the care 
        described in subsections (c) and (d);
            (3) shall ensure that services described in subsection (c) 
        which are not made available by a health center are provided 
        either--
                    (A) through contracts for direct payment to 
                specific networks of providers; or
                    (B) through the purchase of wraparound insurance; 
                and
            (4) shall provide for payments in accordance with 
        subsection (b).
    (b) Payments.--
            (1) In general.--Under a qualifying children's direct 
        service benefit option, a State may not--
                    (A) require that a subsidy eligible child in a 
                family with a family income below 185 percent of the 
                poverty line for a family of the size involved pay more 
                than 5 percent of the capitated payment rate;
                    (B) allow the imposition of cost-sharing 
                requirements for preventive services provided to a 
                subsidy eligible child;
                    (C) enter into a contract that requires that a 
                subsidy eligible child (in a family with a family 
                income below 150 percent of the poverty line for a 
                family of the size involved) pay more than 20 percent 
                of the cost-sharing otherwise applied by the health 
                center, unless the cost-sharing required under the 
                contract involved has been deemed by the Secretary as 
                not being a barrier to care for children of families 
                below 150 percent of the poverty line for a family of 
                the size involved.
    (c) Coverage for Medical Care.--For purposes of this title, a 
qualifying children's direct service benefit option is an option for a 
eligible child that provides coverage for medical care for such child 
that either (at the option of the State)--
            (1) is the equivalent of the medical assistance available 
        (other than cost sharing) to children under the State plan 
        under title XIX of the Social Security Act (42 U.S.C. 1396 et 
        seq.), or
            (2) is comparable to the health benefits plan that is 
        offered under the Federal Employees' Health Benefits Program 
        (under chapter 89 of title 5, United States Code) and that is 
        the plan with the largest enrollment of individuals under such 
        Program.
    (d) Access to Specialty Care for Special Needs Children.--Each 
qualified children's direct service benefit option shall assure access 
to pediatric primary and specialty care providers, including centers of 
pediatric specialized treatment expertise.

SEC. 104. OTHER REQUIREMENTS.

    (a) In General.--A participating State shall--
            (1) take steps to ensure that information about the 
        availability of the program, requirements for family 
        participation in the program, benefits offered, and the 
        application process are disseminated effectively to potential 
        participants;
            (2) have in effect an outreach system under which families 
        eligible for assistance under this title are assisted in 
        enrolling in the State program and are enrolled at a wide 
        variety of locations, including through of traditional 
        providers of care;
            (3) ensure that every subsidy eligible children have the 
        opportunity to apply for assistance under the State program 
        under this title pursuant to State law;
            (4) if the State determines that a child is eligible for 
        cost-sharing assistance under this title, notify the health 
        plan in which such child is participating in a timely manner of 
        such eligibility;
            (5) provide to any subsidy eligible child whose claim for 
        assistance under the State program is denied or is not acted on 
        within a reasonable period of time, an opportunity under State 
        law for an administrative hearing on such denial or inaction 
        before the State agency;
            (6) provide to the public, a general description of the 
        rules (including the objective criteria used) established by 
        the State for making decisions concerning eligibility for 
        assistance under the State program; and
            (7) use funds received under this title only in accordance 
        with the provisions of this title.
    (b) Designation of State Agency.--A participating State may 
designate an appropriate State agency to administer the State program 
under this title.

                         Subtitle B--Assistance

                     Part 1--Assistance to Families

SEC. 121. ELIGIBILITY DETERMINATIONS.

    (a) In General.--The following requirements shall apply with 
respect to eligibility determinations for assistance under this title:
            (1) Applications.--A State program shall provide that an 
        individual may file an application for assistance in any manner 
        determined appropriate by the State. Such applications shall--
                    (A) be in an understandable form and generally 
                accessible to individuals;
                    (B) require the provision of information necessary 
                to make a determination as to whether a child is 
                eligible for assistance; and
                    (C) require attachment of such documentation as 
                deemed necessary by the Secretary in order to verify 
                eligibility for assistance.
            (2) Term.--The State program may provide for a 
        determination of eligibility under this section to be effective 
        for a 6-month period or longer.
    (b) Coordination.--Eligibility determinations made pursuant to this 
section may be coordinated with determinations of eligibility for 
State-administered health programs to the extent that such coordination 
brings about administrative efficiencies.

SEC. 122. ASSISTANCE TO FAMILIES.

    (a) State Applicable Income Criteria.--For purposes of this title, 
the applicable income criteria used by the State for purposes of 
determining whether a child is a subsidy eligible child, shall be based 
on the income of the family of the subsidy eligible child expressed as 
a percentage of the poverty line for a family of the size involved. In 
establishing the applicable eligibility criteria and subsidy level, the 
State shall give priority to families in the State with the lowest 
family incomes, except that the State shall establish a higher income 
criterion for families with a disabled child.
    (b) Payments.--
            (1) In general.--The amount of the assistance available to 
        a subsidy eligible child shall be paid directly to--
                    (A) in the case of a child enrolled in a qualifying 
                children's policy, the health insurance issuer offering 
                the qualifying children's policy (unless such plan is a 
                group health plan in which case such payment may be 
                made directly to the group health plan or the health 
                insurance issuer offering health insurance coverage 
                through the group health plan, or to the individual); 
                or
                    (B) in the case of an individual receiving benefits 
                under a qualifying children's direct service benefit 
                option, to the provider and the health insurance issuer 
                if applicable with whom the State has contracted under 
                section 103.
            (2) Individual responsibility.--An individual shall be 
        responsible for any portion of the premium or cost sharing not 
        subsidized by the State.
    (c) Special Rule.--
            (1) In general.--If a subsidy eligible child enrolls in a 
        group health plan, a premium subsidy under this title shall be 
        applied only to the amount of the employee contribution for 
        coverage for a subsidy eligible child.
            (2) Rule of construction.--Nothing in this section shall be 
        construed to require that an employer provide a qualifying 
        children's policy to an eligible child regardless of whether 
        such child is eligible for a subsidy under this title.
    (d) Limitation.--Nothing in this title shall be construed to 
require that a State provide assistance to subsidy eligible children 
under this subtitle in an amount that exceeds the total amount 
available to the State under section 126 (including State matching 
funds) for carrying out the program under this title. If the State 
determines that such available amount is not sufficient to provide 
premium subsidies and other assistance under this subtitle to all 
subsidy eligible children in the State, the State may adjust the 
applicable eligibility criteria appropriately or adjust the State 
program in another manner specified by the Secretary prior to the 
program year.

SEC. 123. PENALTIES FOR MATERIAL MISREPRESENTATION AND FALSE 
              INFORMATION.

    A participating State shall establish penalties to be applied to 
any individual who knowingly and willfully makes a material 
misrepresentation of information or provides false information in an 
application for assistance under this subtitle, and shall otherwise 
enforce the provisions of this title as determined appropriate by the 
State.

SEC. 124. AGGREGATE FEDERAL GRANT PAYMENTS.

    (a) Payment Schedule.--
            (1) State amount.--
                    (A) In general.--A participating State shall be 
                eligible to receive a grant in an amount under this 
                title that bears the same relationship to the amount 
                appropriated for such year under section 125 (and 
                available after the reservation under paragraph (7)), 
                as the total number of uninsured eligible children in 
                the State in a base year as determined appropriate by 
                the Secretary bears to the total number of uninsured 
                eligible children in all participating States in such 
                base year.
                    (B) State allocation adjustments.--
                            (i) Study.--Not later than September 30, 
                        1998, the Secretary shall conduct a study, and 
                        prepare and submit to the appropriate 
                        committees of Congress a report, concerning 
                        methodology for providing the State allotment 
                        under subparagraph (A) that takes into account 
                        an equitable adjustment to the formula based on 
                        variations in costs among States.
                            (ii) Implementation of methodology.--If 
                        determined appropriate and feasible by the 
                        Secretary, the Secretary shall, not later than 
                        January 1, 1999, implement by regulation a 
                        methodology for the determination of the 
                        maximum amount under subparagraph (A) that 
                        takes into account the relative number of 
                        uninsured eligible children in a State in the 
                        base year described in subparagraph (A) and the 
                        relative cost of the delivery of services to 
                        those children.
            (2) Payment.--Subject to paragraph (1), the Secretary shall 
        provide for payment under a grant to each participating State 
for each calendar quarter, beginning with any quarter beginning on or 
after April 1, 1998, of an amount equal to--
                    (A)(i) 100 percent of the total amount estimated by 
                the Secretary to have been expended by the State during 
                such prior quarter for premium and cost-sharing 
                assistance under this title for enrollment in 
                qualifying children's policies and for coverage under 
                the qualifying children's direct service benefit option 
                through the programs operated under subtitle A; less
                    (ii) the State matching amount as determined under 
                paragraph (3) for such prior quarter; and
                    (B) 50 percent of the total amount estimated by the 
                Secretary to be expended by the State during such prior 
                quarter for the proper and efficient administration of 
                the program described in this subtitle.
            (3) State matching percentage.--
                    (A) In general.--With respect to the calendar 
                quarter for which the payment is to be made under this 
                section, the State will be responsible for contributing 
                an amount equal to 40 percent of the percentage of the 
                amount the State is responsible for expending for 
                medical assistance under title XIX of the Social 
                Security Act, based on the State percentage determined 
                under section 1905(b) of such Act (42 U.S.C. 1396d(b)), 
                for the State for the calendar quarter involved.
                    (B) Limitation.--In no case shall the State 
                responsibility under subparagraph (A) for a calendar 
                quarter be less than an amount equal to 10 percent of 
                the amount determined under paragraph (2)(A)(i) for the 
                State for the calendar quarter involved.
                    (C) Territories.--In the case of Puerto Rico, the 
                Virgin Islands, Guam, American Samoa, and the Northern 
                Mariana Islands, the State percentage for purposes of 
                determining the State matching amount under 
                subparagraph (A) shall be 20 percent.
            (4) Availability of funds.--Except as provided in paragraph 
        (5), amounts provided to a State under this section shall 
        remain available until expended by the State.
            (5) Redistribution.--The Secretary shall establish a 
        procedure for the redistribution of any funds--
                    (A) not expended by a State under this title; and
                    (B) as determined by the Secretary, after 
                consultation with the governor of the State, that are 
                unlikely to be used in the future by the State.
            (6) State request for reduction in funds.--Nothing in this 
        section shall be construed to prohibit a State from requesting 
        only a portion of the amount allotted to the State under this 
        section.
            (7) Reservation.--
                    (A) In general.--Of the amount appropriated to 
                carry out this title for a fiscal year, the Secretary 
                shall reserve .15 percent of such amount for allocation 
                among the territories described in paragraph (2)(C).
                    (B) Allocation.--A territory described in paragraph 
                (2)(C) shall be eligible to receive an amount that 
                bears the same relationship to the amount reserved for 
                such year under subparagraph (A), as the total number 
                of uninsured eligible children in the territory in a 
                base year as determined appropriate by the Secretary 
                bears to the total number of uninsured eligible 
                children in all participating territories in such base 
                year.
    (b) Reduction in Payments for Administrative Errors.--
            (1) In general.--In the case of administrative errors 
        described in paragraph (2), matching payments available to a 
        State under subsection (a) shall be reduced by an amount 
        determined appropriate by the Secretary.
            (2) Administrative errors described.--The administrative 
        errors described in this paragraph include the following:
                    (A) An eligibility error rate for premium 
                assistance to the extent the applicable error rate 
                exceeds the maximum permissible error rate specified by 
                the Secretary.
                    (B) Misappropriations or other expenditures that 
                the Secretary finds are attributable to malfeasance or 
                misfeasance.
    (c) Audits.--The Secretary shall conduct regular audits of the 
activities conducted under this subtitle.
    (d) Budgetary Treatment.--Subject to section 125, this section 
constitutes budget authority in advance of appropriations Acts, and 
represents the obligation of the Federal Government to provide payments 
to the States in accordance with this section.
    (e) Nonentitlement.--Nothing in this title shall be construed as 
providing an individual with an entitlement to assistance under this 
title.

SEC. 125. AUTHORIZATION OF APPROPRIATIONS AND DEFICIT REDUCTION.

    (a) Authorization of Appropriations.--There is authorized to be 
appropriated to make Federal payments under this title--
            (1) for fiscal year 1998, $3,000,000,000;
            (2) for fiscal year 1999, $3,000,000,000;
            (3) for fiscal year 2000, $4,000,000,000;
            (4) for fiscal year 2001, $5,000,000,000; and
            (5) for fiscal year 2002, $5,000,000,000.
    (b) Deficit Reduction Targets.--For purposes of this section, the 
deficit reduction target shall be--
            (1) for fiscal year 1998, $3,000,000,000;
            (2) for fiscal year 1999, $3,000,000,000;
            (3) for fiscal year 2000, $2,000,000,000;
            (4) for fiscal year 2001, $1,000,000,000; and
            (5) for fiscal year 2002, $1,000,000,000.
Any amount of revenue available under this subsection shall be 
deposited into the Treasury and used for deficit reduction.
    (c) Reduction in Authorized Amount.--
            (1) In general.--If, with respect to a fiscal year, the 
        total estimated amount of revenue derived for the financing of 
        the program under this title is less than the total target 
        amount determined under paragraph (2), then the amount referred 
        to for the following fiscal year under subsection (a) shall be 
        reduced by the amount by which the amount of such estimated 
        revenue is less than the total target amount determined under 
        paragraph (2) for such fiscal year multiplied by \2/3\.
            (2) Total target amount.--For purposes of paragraph (1), 
        the total target amount for a fiscal year shall be equal to the 
        sum of--
                    (A) the amount authorized to be appropriated for 
                such year under subsection (a); and
                    (B) the deficit reduction target for such fiscal 
                year under subsection (b).
            (3) Revenue in excess of estimates.--If the estimated 
        amount of revenue described in paragraph (1) for a fiscal year 
        is greater than the total target amount under paragraph (2) for 
        such fiscal year, then the amount authorized for the following 
        fiscal year under subsection (a) shall be increased in the same 
        manner as the reduction described in paragraph (1).

     Part 2--Services for Pregnant Women, New Mothers, and Infants

SEC. 131. PROGRAM FOR PREGNANT WOMEN AND INFANTS.

    (a) Establishment of Program.--A participating State may use up to 
5 percent of the amount of the allotment to the State for a fiscal year 
under section 125 to establish a program to meet the needs identified 
by the State in the statewide needs assessments prepared by the States 
under section 505(a)(1)(A) of the Social Security Act (42 U.S.C. 
705(a)(1)(A)).
    (b) Coordination.--A State shall take actions to ensure that the 
program established under this section is coordinated with the programs 
operated by the State under title V of the Social Security Act (42 
U.S.C. 705).
    (c) Maintenance of Effort.--With respect to a State that carries 
out a program under this section, funds made available under this title 
for such program shall be used to supplement and not supplant current 
State spending for the needs described in subsection (a).

          Subtitle C--Definitions and Miscellaneous Provisions

                          Part 1--Definitions

SEC. 141. DEFINITIONS.

    (a) In General.--In this title:
            (1) Eligible child.--The term ``eligible child'' means an 
        individual who is 18 years of age or younger.
            (2) Participating state.--The term ``participating State'' 
        means any State that elects to establish a program under 
        subtitle A.
            (3) Poverty line.--The term ``poverty line'' means the 
        income official poverty line (as defined by the Office of 
        Management and Budget, and revised annually in accordance with 
        section 673(2) of the Omnibus Budget Reconciliation Act of 
        1981) that is applicable to a family of the size involved.
            (4) Qualifying children's policy.--The term ``qualifying 
        children's policy'' means a policy that meets the standards 
        described in section 102.
            (5) Qualifying children's direct service benefit option.--
        The term ``qualifying children's direct service benefit 
        option'' means the provision of direct medical assistance under 
        the standards described in section 103.
            (6) State.--The term ``State'' means each of the several 
        States, the District of Columbia, Puerto Rico, the Virgin 
        Islands, Guam, American Samoa, and the Northern Mariana 
        Islands.
            (7) Subsidy eligible child.--The term ``subsidy eligible 
        child'' means a child who--
                    (A) meets reasonable eligibility criteria 
                established by the State, and has a family income that 
                falls within the applicable income criteria (as defined 
                in section 122), for purposes of providing subsidies 
                under the State program;
                    (B) is an eligible child;
                    (C) is a citizen or qualified alien (as defined in 
                section 431(b) of the Personal Responsibility and Work 
                Opportunity Reconciliation Act of 1996 (8 U.S.C. 
                1641(b));
                    (D) is not eligible for medical assistance under 
                the State plan under title XIX of the Social Security 
                Act, except that nothing in this title shall be 
                construed to require that an individual be denied 
                medical assistance under a State plan under title XIX 
                of the Social Security Act (42 U.S.C. 1396 et seq.) in 
                order for that child to be eligible to receive 
                assistance under the State program under this title; 
                and
                    (E) has not been covered under a group health plan 
                (unless such coverage was terminated as a result of a 
                change in employment status) during the 6-month period 
                ending on the date on which the individual applies for 
                subsidy-eligible health coverage under this title.
        For purposes of subparagraph (E), enrollment in a health plan 
        under a COBRA continuation provision (as defined in section 
        2791(d)(4) of the Public Health Service Act) shall not 
        constitute enrollment in a group health plan.
    (b) Definitions Relating to Income.--In this title:
            (1) Family income.--The term ``family income'' means, with 
        respect to an individual who--
                    (A) is not a dependent of another individual, the 
                sum of the modified adjusted gross incomes for the 
                individual, the individual's spouse, and children who 
                are dependents of the individual; or
                    (B) is a dependent of another individual, the sum 
                of the modified adjusted gross incomes for the other 
                individual, the other individual's spouse, and children 
                who are dependents of the other individual.
        The Secretary may promulgate rules under which spousal income 
        may be disregarded in instances where a spouse is not part of a 
        family unit.
            (2) Dependent.--The term ``dependent'' has the meaning 
        given such term under section 152 of the Internal Revenue Code 
        of 1986. For purposes of this paragraph, a child who is placed 
        in foster care by a State agency shall not be considered a 
        dependent of another individual.
            (3) Modified adjusted gross income.--The term ``modified 
        adjusted gross income'' means adjusted gross income (as defined 
        in section 62(a) of the Internal Revenue Code of 1986)--
                    (A) determined without regard to sections 135, 
                162(l), 911, 931, and 933 of such Code, and
                    (B) increased by--
                            (i) the amount of interest received or 
                        accrued by the individual during the taxable 
                        year which is exempt from tax, and
                            (ii) the amount of the social security 
                        benefits (as defined in section 86(d) of such 
                        Code) received during the taxable year to the 
                        extent not included in gross income under 
                        section 86 of such Code.
        The determination under the preceding sentence shall be made 
        without regard to any carryover or carryback.
    (c) Other Definitions.--The term--
            (1) ``group health plan'' has the meaning given the term in 
        section 2791(a) of the Public Health Service Act;
            (2) ``health insurance coverage'' has the meaning given the 
        term in section 2791(b)(1) of such Act;
            (3) ``health insurance issuer'' has the meaning given the 
        term in section 2791(b)(2) of such Act;
            (4) ``health maintenance organization'' has the meaning 
        given the term in section 2791(b)(3) of such Act; and
            (5) ``network plan'' has the meaning given the term in 
        section 2791(B)(10) of such Act.
    (d) References to Individual.--For purposes of this title, any 
reference to an individual shall include a reference to the parent or 
guardian of such individual.

                    Part 2--Miscellaneous Provisions

SEC. 151. OTHER CONTRIBUTIONS TO PREMIUMS.

    (a) General Rule.--Any employer which elects to make employer 
contributions on behalf of an individual who is an employee of such 
employer, or who is a dependent of such employee, for health insurance 
coverage shall not condition, or vary, such contributions with respect 
to any such individual by reason of such individual's status as an 
individual eligible for assistance under subtitle B.
    (b) Elimination of Contributions.--An employer shall not be treated 
as failing to meet the requirements of subsection (a) if the employer 
ceases to make employer contributions for health insurance coverage for 
all its employees.
    (c) Enforcement.--The enforcement provisions applicable to group 
health insurance coverage under the amendments made by section 
101(e)(2) of the Health Insurance Portability and Accountability Act of 
1996 shall apply with respect to an employer that violates the 
provisions of this section in the same manner as such provisions apply 
to employers under such amendments.

SEC. 152. MAINTENANCE OF EFFORT.

    (a) Medicaid.--A State that elects to participate under this title 
may not modify the eligibility requirements for children under the 
State program under title XIX of the Social Security Act, as in effect 
on January 1, 1997 (except that such requirements may be modified 
pursuant to an application for a waiver under section 1115 of the 
Social Security Act (42 U.S.C. 1315) submitted prior to January 1, 
1997), in any manner that would have the effect of reducing the 
eligibility of children for coverage under such program.
    (b) Maintenance of Effort.--Funds appropriated pursuant to the 
authority of this title shall be used to supplement and not supplant 
other Federal and State funds expended to provide services for disabled 
individuals.

SEC. 153. APPLICATION OF OTHER REQUIREMENTS AND STATE FLEXIBILITY.

    (a) Application of Insurance Requirements Under Title XXVII.--For 
purposes of applying sections 2701(a) through (e) and (g) of the Public 
Health Service Act (relating to limitations on preexisting conditions 
and increased portability) except those provisions relating to late 
enrollees, waiting periods, and election of alternative methods under 
sections 2701(c)(3)(B), 2702(a)(1) and (b) (relating to eligibility to 
enroll), 2711(a)(1)(A) (relating to guaranteed availability for 
eligible individuals), and 2711(c) and (d)(1) (relating to special 
rules for network plans and financial capacity) of such Act to health 
insurance issuers offering a qualifying children's policy and health 
insurance issuers offering wrap-around insurance under this title, a 
qualifying children's policy shall be deemed to be health insurance 
coverage offered by a health insurance issuer in the small group 
market, in connection with a group health plan, and an eligible 
individual shall be considered a small employer for the purposes of 
section 2711(a)(1)(A), (c) and (d)(1) of such Act, except that section 
2701(b) of such Act shall apply to a qualifying children's policy 
offered to a subsidy eligible child.
    (b) State Flexibility.--Nothing in this section shall be construed 
to prevent a State from establishing or implementing standards or 
requirements--
            (1) not prescribed in this title; or
            (2) related to the issuance, renewal or portability of 
        health insurance under a qualifying children's policy or a 
        qualifying children's direct service benefit option that 
        provide greater protection or benefit to an eligible child.

SEC. 154. REGULATIONS.

    The Secretary may issue regulations to implement the program 
established under this title.

             Part 3--Conforming Amendments; Effective Date

SEC. 161. CONFORMING AMENDMENTS.

    (a) ERISA.--Section 701(c)(1) of the Employee Retirement Income 
Security Act of 1974 (as added by section 101(a) of the Health 
Insurance Portability and Accountability Act of 1996) is amended by 
adding at the end the following:
                    (K) A qualifying children's policy under title I of 
                the Child Health Insurance and Lower Deficit Act of 
                1997.'''.
    (b) Public Health Service Act.--
            (1) Section 2701(c)(1) of the Public Health Service Act (as 
        added by section 102(a) of the Health Insurance Portability and 
        Accountability Act of 1996) is amended by adding at the end the 
        following:
                    ``(K) A qualifying children's policy under title I 
                of the Child Health Insurance and Lower Deficit Act of 
                1997.''.
            (2) Section 2761(b)(1)(A) of the Public Health Service Act 
        (as added by section 102(a) of the Health Insurance Portability 
        and Accountability Act of 1996) is amended--
                    (A) by striking ``or church plan'' and inserting 
                ``church plan''; and
                    (B) by inserting before the semicolon the 
                following: ``, qualifying children's policy, or 
                qualifying children's direct service benefit option''.

SEC. 162. EFFECTIVE DATE.

    This title shall become effective on the date of enactment of this 
Act, except that funds to carry out programs under this title shall not 
be available prior to January 1, 1998.

         TITLE II--INCREASE IN EXCISE TAXES ON TOBACCO PRODUCTS

SEC. 201. INCREASE IN EXCISE TAXES ON TOBACCO PRODUCTS TO FUND CHILD 
              HEALTH INSURANCE GRANTS AND LOWER THE DEFICIT.

    (a) Cigarettes.--Section 5701(b) of the Internal Revenue Code of 
1986 is amended--
            (1) in paragraph (1), by striking ``$12 per thousand ($10 
        per thousand on cigarettes removed during 1991 or 1992)'' and 
        inserting ``$33.50 per thousand'', and
            (2) in paragraph (2), by striking ``$25.20 per thousand 
        ($21 per thousand on cigarettes removed during 1991 or 1992)'' 
        and inserting ``$70.35 per thousand''.
    (b) Cigars.--Section 5701(a) of the Internal Revenue Code of 1986 
is amended--
            (1) in paragraph (1), by striking ``$1.125 cents per 
        thousand (93.75 cents per thousand on cigars removed during 
        1991 or 1992)'' and inserting ``$3.141 cents per thousand'', 
        and
            (2) by striking ``equal to'' and all that follows in 
        paragraph (2) and inserting ``equal to 35.59 percent of the 
        price for which sold but not more than $83.75 per thousand.''
    (c) Cigarette Papers.--Section 5701(c) of the Internal Revenue Code 
of 1986 is amended by striking ``0.75 cent (0.625 cent on cigarette 
papers removed during 1991 or 1992)'' and inserting ``2.09 cents''.
    (d) Cigarette Tubes.--Section 5701(d) of the Internal Revenue Code 
of 1986 is amended by striking ``1.5 cents (1.25 cents on cigarette 
tubes removed during 1991 or 1992)'' and inserting ``4.18 cents''.
    (e) Smokeless Tobacco.--Section 5701(e) of the Internal Revenue 
Code of 1986 is amended--
            (1) in paragraph (1), by striking ``36 cents (30 cents on 
        snuff removed during 1991 or 1992)'' and inserting ``$1.00'', 
        and
            (2) by striking ``12 cents (10 cents on chewing tobacco 
        removed during 1991 or 1992)'' in paragraph (2) and inserting 
        ``33.5 cents''.
    (f) Pipe Tobacco.--Section 5701(f) of the Internal Revenue Code of 
1986 is amended by striking ``67.5 cents (56.25 cents on pipe tobacco 
removed during 1991 or 1992)'' and inserting ``$1.88''.
    (g) Effective Date.--The amendments made by this section shall 
apply to articles removed (as defined in section 5702(k) of the 
Internal Revenue Code of 1986) after September 30, 1997.
    (h) Floor Stocks Taxes.--
            (1) Imposition of tax.--On tobacco products and cigarette 
        papers and tubes manufactured in or imported into the United 
        States which are removed before October 1, 1997, and held on 
        such date for sale by any person, there is hereby imposed a tax 
        in an amount equal to the excess of--
                    (A) the tax which would be imposed under section 
                5701 of the Internal Revenue Code of 1986 on the 
                article if the article had been removed on such date, 
                over
                    (B) the prior tax (if any) imposed under section 
                5701 or 7652 of such Code on such article.
            (2) Authority to exempt cigarettes held in vending 
        machines.--To the extent provided in regulations prescribed by 
        the Secretary, no tax shall be imposed by paragraph (1) on 
        cigarettes held for retail sale on October 1, 1997, by any 
        person in any vending machine. If the Secretary provides such a 
        benefit with respect to any person, the Secretary may reduce 
        the $500 amount in paragraph (3) with respect to such person.
            (3) Credit against tax.--Each person shall be allowed as a 
        credit against the taxes imposed by paragraph (1) an amount 
        equal to $500. Such credit shall not exceed the amount of taxes 
imposed by paragraph (1) on October 1, 1997, for which such person is 
liable.
            (4) Liability for tax and method of payment.--
                    (A) Liability for tax.--A person holding cigarettes 
                on October 1, 1997, to which any tax imposed by 
                paragraph (1) applies shall be liable for such tax.
                    (B) Method of payment.--The tax imposed by 
                paragraph (1) shall be paid in such manner as the 
                Secretary shall prescribe by regulations.
                    (C) Time for payment.--The tax imposed by paragraph 
                (1) shall be paid on or before January 1, 1998.
            (5) Articles in foreign trade zones.--Notwithstanding the 
        Act of June 18, 1934 (48 Stat. 998, 19 U.S.C. 81a) and any 
        other provision of law, any article which is located in a 
        foreign trade zone on October 1, 1997, shall be subject to the 
        tax imposed by paragraph (1) if--
                    (A) internal revenue taxes have been determined, or 
                customs duties liquidated, with respect to such article 
                before such date pursuant to a request made under the 
                1st proviso of section 3(a) of such Act, or
                    (B) such article is held on such date under the 
                supervision of a customs officer pursuant to the 2d 
                proviso of such section 3(a).
            (6) Definitions.--For purposes of this subsection--
                    (A) In general.--Terms used in this subsection 
                which are also used in section 5702 of the Internal 
                Revenue Code of 1986 shall have the respective meanings 
                such terms have in such section, as amended by this 
                Act.
                    (B) Secretary.--The term ``Secretary'' means the 
                Secretary of the Treasury or the Secretary's delegate.
            (7) Controlled groups.--Rules similar to the rules of 
        section 5061(e)(3) of such Code shall apply for purposes of 
        this subsection.
            (8) Other laws applicable.--All provisions of law, 
        including penalties, applicable with respect to the taxes 
        imposed by section 5701 of such Code shall, insofar as 
        applicable and not inconsistent with the provisions of this 
        subsection, apply to the floor stocks taxes imposed by 
        paragraph (1), to the same extent as if such taxes were imposed 
        by such section 5701. The Secretary may treat any person who 
        bore the ultimate burden of the tax imposed by paragraph (1) as 
        the person to whom a credit or refund under such provisions may 
        be allowed or made.
                                 <all>